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Experts Offer Advice for Climbing the Nurse Leadership Ladder

September 12, 2012 - A nurse executive or manager is called to be a servant leader, a courageous visionary, a change agent, an excellent listener and a clinical and business expert. Nurses who want to advance for the pay, the prestige or any reason that isn’t ultimately about providing the best care for patients and a positive working environment for nurses will not succeed in the long run.

Here, three successful nurse leaders offer their best advice for nurses who want to move up the nursing leadership ladder and truly make a difference.

All three agree that earning respect is one key to being an effective leader.

Ninfa Saunders, MSN, MBA, PhD, president and CEO of Central Georgia Health System, says nurse leaders need to have business sense as well as clinical expertise.

“Management is a lonely job. You can’t be looking over your shoulder asking, ‘Am I still popular?’ You need to be respected, but you won’t necessarily be popular,” offered Ninfa Saunders, MSN, MBA, PhD, black belt LEAN six-sigma and president and CEO of Central Georgia Health System. “You will find yourself in places no one wants to be in. Can you handle that? And you have to be able to execute plans. Lots of people can talk and talk, but can you show me what you’ve done?”

“To be a leader you have to have followers,” added Karlene Kerfoot, PhD, RN, NEA-BC, FAAN, principal at Kerfoot & Associates, Inc., vice president of nursing for API Healthcare and a Nursing Economic$ editorial board member and columnist. “If people don’t believe in you or don’t respect you or don’t see you as a leader they won’t want to follow you.”

“You don’t have to be everybody’s best friend,” Kerfoot continued, “but they should see you as someone who is supporting them in their career and developing them; not just dictating what to do.”

Serving in nurse leadership requires a broad spectrum of skills and knowledge.

Karlene Kerfoot, PhD, RN, NEA-BC, FAAN, says that nurse leaders need to be resilient, energetic and know how to blow off stress.

“I would say there are three areas of education content that you need to know to be an effective manger and then a leader,” said Kerfoot. “Number one is the science of nursing. If you aren’t well grounded in the science and clinical aspects of nursing, you won’t know how to lead nurses. Second, you need to know the business of health care. Health care is different from other businesses, in part because it is very regulated and changes dramatically every year. Finally, you need to understand business elements, such as financial opportunities and strategic planning.”

Nurses interested in more advanced roles such as nursing director or chief nursing officer (CNO) should pursue a master’s degree either in business or in nursing.

Kelly Hancock, RN, MSN, NE-BC, executive CNO, Cleveland Clinic Health System, has spent her 20-year nursing career at the Clinic where she began as a CNA.

“Pursuing my MSN while working as a nursing director gave me a different point of view on health care. I began thinking about issues such as quality, access and affordability,” remarked Kelly Hancock, RN, MSN, NE-BC, executive CNO of the Cleveland Clinic health system and CNO for the main campus. “I would also encourage nurses to read as much as possible on leadership and obtain certifications.”

Having a collection of degrees, however, isn’t enough to ensure a C-suite job.

“Leadership requires wisdom; taking the knowledge that you’ve learned from academics and integrating and applying it to your work, learning from mistakes and from the people around you,” commented Saunders.

Kerfoot encourages nurses to consider what kind of legacy they hope to leave behind and to create a plan to reach that goal.

“You have to keep your eye on the goal, because if you don’t, you will end up in situations where you are just drifting and not learning much. But if you are focused, you can land in places where you are really learning,” she said. “You need to look for the right boss, not just the right job. Sometimes it is worth taking a side or back step in your career just to have a boss who is fabulous and a good teacher.”

Saunders says one of the most difficult and also most important keys to leadership is consistent authenticity.

“Consistent authenticity requires that you constantly listen to one’s inner self to detect any distortions and then to make corrections. You’d be surprised how experience and wisdom can help you discern, but you can miss it if you are running to the next best project,” she explained.

Leadership is not something done alone. Saunders recommends nurses be involved in their own professional organizations, and consider joining the American organization of Nurse Executives (AONE). She also recommends membership with the American College of Health Care Executives (ACHCE) which is a cross-professional organization with a diversity of talent and thought.

“Health care is ever-changing and we have to transform the way we deliver care at the bedside and that requires strong leaders,” Hancock observed. “Strong leaders surround themselves with a strong team. You need a strong team to make changes.”

“There isn’t one path to leadership. Some people go directly up. You can also have more of a spiral career where you go left and right to have different kinds of experiences that fit for you. There is no ‘right’ way. As a nurse you have tremendous flexibility and tremendous opportunity,” reflected Kerfoot.

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